| NPI | 1538500418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4557) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010748) |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2015-09-11 |